Combined peritoneal dialysis and hemodialysis therapy improves quality of life in end-stage renal disease patients.

The Dialysis Outcomes Quality Initiative (DOQI) guidelines recommend that, for patients on continuous ambulatory peritoneal dialysis (CAPD), a weekly creatinine clearance (WCC) of at least 60 L/1.73 m2 is needed for adequate dialysis. As residual renal function (RRF) declines, maintaining these target levels may become difficult. Over time, declines in ultrafiltration (UF) caused by increases in peritoneal permeability, in conjunction with decreases in RRF, may limit continuation of CAPD therapy. In an effort to achieve adequate solute clearance and ultrafiltration in several CAPD patients at our center who have declining RRF or poor UF, we use combined peritoneal dialysis and hemodialysis (PD + HD) as a therapeutic strategy when individualization of peritoneal dialysis is unsuccessful. At our center, PD + HD consists of five days of PD therapy followed by one HD session per week on Saturday. After the weekly HD session, patients are liberated from bag exchanges until Sunday evening. This PD + HD therapy was used in six cases where poor solute clearance and water retention were refractory to PD therapy alone. The combined therapy was well tolerated, and symptoms related to uremia improved in all six cases. Additionally, improvements in quality of life (QOL) were documented in all patients who were managed with the combined therapy. The improvements in QOL may have resulted from decreases in uremic symptomatology or freedom from bag exchanges. The PD + HD therapy can best be applied in the uremic PD patient without residual renal function whose peritoneal membrane is not deteriorated. The therapy allows for the continuation of PD without shifting to total HD in PD patients who continue to have uremic symptoms even after individualization of the PD prescription. Our patients readily accepted combined therapy, and we have noted excellent compliance with this therapy at our center.